Healthcare Provider Details

I. General information

NPI: 1619112513
Provider Name (Legal Business Name): EYECARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 VALLEYDALE RD SUITE 700
BIRMINGHAM AL
35242
US

IV. Provider business mailing address

PO BOX 207243
DALLAS TX
75320-7243
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-4393
  • Fax: 205-991-9600
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5800 12205
License Number StateAL

VIII. Authorized Official

Name: JAMES WACHTER
Title or Position: CMO
Credential:
Phone: 636-200-4393